Sources Sought Notice - Federally Facilitated Exchange Oversight.docx

Sources Sought Notice (SSN) 210835 Federally Facilitated Exchange (FFE) Oversight

THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE.

This is a SOURCES SOUGHT NOTICE (SSN) to determine the availability of small businesses on the GSA Professional Services Schedule (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that have the capability to support CMS to ensure that web-brokers and issuers meet the required criteria necessary to conduct enrollments using both the classic Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) processes in the Federally-Facilitated Exchange (FFE).

The information gathered from this market research will assist the Government in determining the appropriate acquisition strategy, including whether a set-aside is possible. Interested contractors must submit a capability statement to demonstrate their ability to perform the requirements stated below.

A. General Background

The Patient Protection and Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010 to assist millions of Americans in obtaining affordable health care services and to allow more employers to offer health insurance coverage in a cost-effective manner to their employees. The Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152), which amended and revised several provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010. We refer to the two statutes collectively as the Patient Protection and Affordable Care Act or the “PPACA.”

CMS, and specifically, the Centers for Consumer Information and Insurance Oversight (CCIIO), is broadly responsible for the Marketplace, or Exchange, implementation. CCIIO has promulgated regulations for the establishment and practices of Exchanges in the District of Columbia, States, as well as for the various programs associated with the Exchanges. Section 1311 of the Affordable Care Act (ACA) sets minimum standards for the Exchange covering key areas of consumer protection. The Division of Issuer Compliance & Monitoring (DICM) is a division within CCIIO’s Marketplace Plan Management Group (MPMG). MPMG’s programs and responsibilities related to web-broker and issuer oversight functions include issuer performance scoring, operational audits of issuers and web-broker entities, initiation of corrective actions or other compliance actions against issuers and web-broker entities, and decertifying issuers, as needed. It is also primarily responsible to ensure that web-brokers and issuers meet the required criteria necessary to conduct enrollments using both the classic Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) processes in the Federally-Facilitated Exchange (FFE).

B. Required Knowledge and Experience

At a minimum, the following knowledge and experience are required:

1. PPACA and implementation of related CMS policies

2. Understanding of the current CMS Health Insurance Exchanges and the attributes of the different types of exchanges

3. Experience developing, analyzing, and maintaining performance models, compliance models, corrective action plans, quality assurance plans and standard operating procedures (SOPs)

4. Experience with Healthcare industry claims related analyses

5. Experience with SAS, SPSS, or other statistical analysis software

6. Data Collection, Modeling, Analysis, and Visualization Experience

7. Experience creating and maintaining databases and spreadsheets for analytical reporting

8. Experience developing and implementing communications and training strategies and plans using multiple communications mechanisms

9. Experience developing executive reports, presentations, and related materials summarizing, analyzing, and recommending solutions to trends and lessons learned from compliance reviews and activities

10. Experience and understanding of CCIIO’s processes related to changes in Qualified Health Plan (QHP) status.

11. Experience and understating of Agent Broker oversight activities

12. Experience and understanding of regulations and guidance related to DE and EDE

13. Experience and understanding of CCIIO’s processes related to onboarding of qualified web-brokers, issuers and other partner entities who may participate in enrollment using classic DE and/or EDE processes

14. Experience in conducting comprehensive audit reviews of technical and business operations from qualifying web-brokers and issuers

15. Experience working and coordinating with multiple internal and external stakeholders including state Department of Insurance (DOIs) to gain consensus on actions, resolutions, and other pertinent items.

16. Experience in preparing paperwork reduction act (PRA) packages and 508 process and preparation

C. Capability Statement Requirements

In response to this Sources Sought Notice, CMS is seeking capability statements. Capability statements are NOT proposals and do not address price/cost. Industry is merely asked to provide information, which may demonstrate that they have expertise and capacity to meet the requirements of this work as a prime contractor, with subcontractors, as they deem necessary.

CMS requests that the respondent specifically address the requirements listed below. Respondents should provide enough information for CMS to make an informed determination of their capability to perform the work as identified below. Please remember that the potential offeror or prime contractor must be able to perform at least 50% of the labor associated with this effort. Please provide a list of contract numbers that your organization has had (if applicable) and your role on the contract (prime contractor or subcontractor). If you were a subcontractor on a particular contract, please clarify the work that you did on that contract.

Teaming Arrangements

Firms seeking to respond to this notice as a team or to rely on subcontractors to perform any portion of the work must include the above-requested information and certifications for each entity on the proposed team or each proposed subcontractor. Responses must clearly indicate the nature of the teaming arrangement.

The contractor and any subcontractors must not have any relationships or arrangements through business operations or its employees that could be considered as possibly lessening the company’s objectivity concerning any aspect of the proposed tasks. If such relationships or arrangements exist, contractors or subcontractors shall be required, during the procurement process (if one occurs), to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated.

Please describe your capabilities and detailed experience performing activities similar to those described below:

1. The capability to identify, analyze, monitor, and document the data elements that will enable CMS to identify and display at-risk issuers, issues impacting partners and consumers, and other relevant metrics related to monitoring agent broker, web-broker and issuer performance.

2. The capability to revise and maintain a Data Analysis Protocol for utilizing MPMG’s incoming issuer data with other data received by or accessible to CCIIO, such as machine readable data, internal audit results from various CCIIO groups or CMS components and third party audit results as well as any other relevant types of available data to inform issuer performance monitoring. The capability includes the ability to determine if data exists in-house, can be collected, and stored in a secure environment, and displaying the data in conjunction with current and future IT systems.

3. The capability to maintain and enhance a progressive compliance model, including business process flows, written policies and procedures encompassing communications protocols, disciplinary guidelines, and corrective action plans, and other documents for use when QHP issuers appear to be out of compliance. The model addresses each phase of the compliance process, which may include warning letters, implementing corrective action plans, civil monetary penalties, etc.

4. The capability to create, maintain and update the SOPs related to this contract, including but not limited to the progressive compliance model, issuer compliance plans, plan suppression, decertification, civil monetary penalties, web-broker onboarding, issuer onboarding, mini-audit and third party audit review, help desk, and activities relating to involvement with the exchanges.

5. The capability to update and maintain a process for conducting reviews of QHP issuer compliance with standards for machine readable provider and formulary data and posting this data on their websites as specified by HHS.

6. The capability to develop, implement and maintain a strategy for providing compliance guidance and training to QHP issuers, as well as providing technical assistance to states regarding issuer compliance matters. This includes training agendas, curriculum, schedules, and webinars as appropriate.

7. The capability to develop reports, presentation slides, and other related materials that summarize, analyze, and provide recommendations related to aggregate trends and lessons learned from annual compliance reviews and other compliance activities.

8. The capability to review and enhance guidelines and requirements, including but not limited to enhanced DE, agent brokers and web-broker processes. This may include regulatory updates, change requests, FAQs, rulemaking support, and regulatory impact assessment. These activities may include analyzing existing compliance review protocols, observations, findings, and reports to determine if they conform to underlying statutory and regulatory authority and updating appropriately.

9. The capability to create, review and enhance agent broker, web-broker and issuer compliance and EDE content and training, tracking processes, webinars, audit templates and toolkits, internal clearance support, notices of non-compliance, technical assistance, and outreach.

10. The capability to support CMS with oversight and enforcement activities for agents and brokers enrolling consumers in coverage through the FFEs that will prevent, minimize, and protect against future harm, financial or otherwise, to consumers and the FFE.

11. The capability to conduct multiple simultaneous audits, oversight and outreach activities of web-brokers, issuers and entities participating in FFE activities. The audit and oversight activities include compliance with regulatory, DE, EDE and privacy & security requirements, web broker/issuer agreement and CMS expectations, including but not limited to, secure intake and review of all submissions, coordination with internal and external parties, pre/post go-live continuous monitoring, compliance of test environments, technical assistance communication, checklist and status tracking.

12. The capability to determine instances in which a Paperwork Reduction Act (PRA) package is necessary and the capability to prepare PRA packages to be routed through the approval process.

13. The capability to provide oversight including regular review of enrollment data, selected market surveillance activities, and facilitating regular communication with State DOIs.

D. Instructions for Submitting Responses to CMS

The following specific information is requested: (a) company descriptive literature; (b) specific related corporate experience; (c) experience with the type of capability expectations mentioned above; (d) references, to include points of contact, email addresses, and phone numbers; and (e) Business information outlined below.

a. DUNS

b. Company Name

c. Company Address

d. Validation of small business status under NAICS Code 541990- All Other Professional, Scientific and Technical Services and 541611 - Administrative Management and General Management Consulting Services (size standard of $16.5 million for both)

e. Current GSA Schedules appropriate to this Sources Sought Notice

Please limit your documentation to the following Page Size, Font Type and Size, Spacing and Page Numbering. Responses shall be submitted using a Microsoft Word /document with page size 8.5 by 11 inches. Font type shall be Times New Roman, size 10-12 using standard tabs and indent software features with no less than single spacing between lines. Responses are limited to no more than ten (10) pages for the entire capability statement.

All transmitted information marked proprietary shall be treated as such. Therefore, businesses should identify any proprietary information in their responses. Proprietary materials will neither be distributed, nor discussed with, any other organization. Information submitted in response to this will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts.

Respondents should be aware that this SSN is for marketing purposes only and any responses thereto, or lack thereof, will not constitute a commitment by CMS to treat any potential offeror more or less favorably in the anticipated forthcoming solicitation and/or ultimate award. Please be advised that CMS will not respond directly to organizations submitting information in response to this SSN.

All capability statements can be submitted via e-mail to Rachel.Johnson@cms.hhs.gov. Responses must be submitted no later than 11:00 AM EST, December 9, 2020.